Provider Contracts & Network Management Expert

Cobalt Benefits Group LLC; Providence (RI); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

HSA contributions

Life Insurance

Disability

401(k) match

Paid holidays

Paid vacation

Tuition reimbursement

Wellness reimbursement

Volunteer day

Job summary

The Healthcare Provider Network & Contract Management Specialist at Cobalt Benefits Group is responsible for maintaining and updating provider and contract data within the health plan system. You will implement client-specific provider contracts, validate configurations, and develop testing scenarios to ensure accurate pricing and claims processing before deployment.

You will coordinate with internal teams, clients, and partners to maintain data integrity, support tiering, and monitor network

Qualifications

• Associate degree or equivalent combination of education and experience.
• Three or more years of related experience preferred.
• Proficiency with Outlook, Excel, and Word.
• Experience with provider contracts, network maintenance, reimbursement validation, contract configuration, or healthcare network tiering.
• Experience with 835 and 837 electronic claim files preferred.
• Strong customer service skills.
• Excellent organizational, analytical, and problem-solving abilities.
• Ability to prioritize, multitask, and work independently in a fast-paced environment.
• Strong written and verbal communication skills.

Responsibilities

• Implement, configure, and maintain client-specific provider contracts, reimbursement methodologies, pricing arrangements, and related system records.
• Validate contract configuration against approved client requirements, source documentation, fee schedules, and reimbursement methodologies.
• Develop, document, and execute contract testing scenarios to ensure accurate pricing, reimbursement, and claims processing outcomes prior to implementation or production updates.
• Coordinate contract implementation and maintenance activities with internal departments, network partners, clients, and other stakeholders.
• Maintain organized and accurate documentation related to provider networks, contracts, pricing arrangements, affiliations, tiering structures, and implementation decisions.
• Support provider network tiering setup, validation, testing, and ongoing maintenance activities.
• Monitor medical and dental network changes to ensure updates are implemented accurately, consistently, and in a timely manner.
• Perform provider contract and pricing maintenance, including the identification and resolution of configuration discrepancies.
• Import and analyze 835 and 837 electronic claim files to support contract validation, reimbursement analysis, and provider maintenance activities.
• Respond to provider, network, and contract-related requests within established service standards.
• Support audits, quality reviews, issue resolution, and continuous improvement initiatives related to provider data, contract configuration, network maintenance, and reimbursement accuracy.

Skills

Provider contracts

Network maintenance

Reimbursement validation

Contract configuration

Customer service

Analytical skills

Organizational skills

Education

Associate degree

Tools

Microsoft Office

Job description

The Healthcare Provider Network & Contract Management Specialist at Cobalt Benefits Group is responsible for maintaining and updating provider and contract data within the health plan system. You will implement client-specific provider contracts, validate configurations, and develop testing scenarios to ensure accurate pricing and claims processing before deployment.

You will coordinate with internal teams, clients, and partners to maintain data integrity, support tiering, and monitor network